PATIENT CONFIDENTIALITY STATEMENT Federal and state laws and regulations require Owensboro Health, Inc.(Owensboro Health) to protect patient information, to train its workforce (including students and volunteers) about patient confidentiality, and to require its vendors and contracted laborers to agree to certain restrictions on the use and disclosure of patient information. While these laws and regulations cover all patients (even those who have died), there are specific restrictions on information related to AIDS/HIV status, mental health, chemical dependency, and alcoholism. Using patient information improperly or disclosing patient information (releasing it to persons or entities outside of Owensboro Health) improperly might result in criminal charges for, among other things, identity theft or fraud, as well as for violations of the Health Insurance Portability and Accountability Act (“HIPAA”) or the Federal Law on Confidentiality of Substance Abuse Patient Records and the regulations relating to these statutes. Persons convicted of a criminal charge relating to misuse or improper disclosure of patient information face monetary penalties or imprisonment, and may be required to compensate the victim. Using patient information improperly or disclosing patient information improperly may also result in a lawsuit alleging, among other things, invasion of privacy, defamation (harming the reputation), libel, or slander. In addition to the legal concerns surrounding the misuse or inappropriate disclosure of patient information, the core commitments of Owensboro Health require that all patients be treated with respect, and have their privacy protected in accordance with applicable laws and with Owensboro Health policies. All employees, students, vendors, volunteers, and contracted laborers are therefore held accountable for the observation of applicable laws and Owensboro Health policies concerning patient information (including account information). Each employee, student, vendor, volunteer, and contracted laborer is expected to maintain the confidentiality of patient information even after his/her relationship with Owensboro Health ends. Breach of confidentiality is defined as unauthorized use, discussion or release of confidential information regarding patients, their identity, and/or their medical or financial records (hard copy and computer). This includes unauthorized retrieval of records on the computer, checking labs or other data without a need to do so, and conversations or discussions that may be overheard by unauthorized persons. Breach of confidentiality is considered a major offense at Owensboro Health. A breach of confidentiality justifies immediate termination of employee/student/vendor/volunteer/contracted laborer status without regard to the employee’s/student’s/vendor’s/volunteer’s/contracted laborer’s length of service or prior record or conduct. By signing below, I certify that I understand the importance of maintaining patient confidentiality and that I agree to abide by the privacy and security policies and procedures adopted by Owensboro Health. I further certify that I have received training on HIPAA’s privacy, data breach and security rules. I understand that I may be subject to immediate termination for breach of patient confidentiality if I am an employee of Owensboro Health, or to have my status as a student, volunteer, vendor, or contracted laborer terminated immediately if I am an employee, student, volunteer, vendor, or contracted laborer. By signing this Statement, the undersigned agrees to be bound by the terms hereof and acknowledges his/her understanding that any breach of this Statement shall subject the undersigned to legal action by Owensboro Health, including a claim for recovery of all losses, damages, claims, and expenses (including reasonable attorney fees) relating to breach of this Statement. _________________________________________________ Signature _________________________________________________ Print Name _____________________ Date